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It was almost inevitable that health care would end up in a partisan and ideological tangle. You don't re-shape 17% of the GDP easily, even if you have a mandate. The stimulus bill set the pattern. A popular new president in the glow of his honeymoon got a near party-line vote on his number one priority in the midst of an economic crisis. The parties are too polarized to expect anything else.

And health care reform came at the worst possible time for its advocates. In the midst of the deepest recession since the 1980s, there's no extra money and broad-based public concern about massive deficit spending. The Democrats have no choice but to produce a health care bill of some sort, if they want to avoid another 1994-style Republican landslide.

They have to pass a bill to keep Democratic voters engaged and happy. Half a loaf might be sufficient to prevent a low turnout of Democrats for the midterms. But if it's just a quarter of a loaf, the liberal base's grumbling would be deafening. The base's disillusionment would diminish fund-raising, organizational activity, and voter turnout among Democrats in 2010. How the eventual bill is defined--how the remaining loaf is described by activists--is one key to 2010. The Republican calculus is totally different. In a sense, they win either way, though victory is sweeter if Obama-care follows Clinton-care into the graveyard. If no health care bill passes, Republicans claim credit, and their crowing will likely act to depress Democratic turnout and pump up GOP turnout in '10. Such a triumph could produce a big GOP congressional sweep. If some modest health care reform passes, Republicans would still gain in both houses of Congress, as one would expect in a midterm election. Yet the pick-ups would fall short of a takeover in either house. GOP turnout will be solid, and on average, Republican turnout may well exceed Democratic turnout (unlike in 2008, when the reverse pattern prevailed. Still, Democrats wouldn't be as turned off, and their participation in '10 would stave off a true electoral disaster. Assuming a reform bill passes, there are long-term consequences for both parties well beyond 2010. Having overwhelmingly opposed reform, Republicans will hang every problem and glitch in the reforms' implementation around Democrats' necks for many years to come. The President and the Democrats will own the reforms. If the reforms add to the national debt after promises They will be paid for, the GOP will pounce again and again. If voters are unhappy with the size of their assessed fees or are forced to make changes in their family health care plans that they detest, the Democrats will pay the price. Of course, if the Democratic reforms work and Americans become happier with health care, the Democrats will gain long-term. That's exactly what happened with Medicare, and Social Security too. When the stakes are very high, as in this debate, the parties play for durable chips.

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